DESCRIPTION: When it is not feasible to remove strenuous lifting tasks by re-engineering, training in lifting techniques is relied upon heavily to help prevent occupationally related back injuries. Laboratory studies have shown that variations in lifting technique can have a large impact on the spinal loads experienced during manual material handling tasks. Thus, the use of good lifting techniques should reduce the risk of back injury. However, there is limited evidence that back injury prevention programs which rely on education and training in "safe" lifting techniques are successful at preventing injuries. The failure of previous training interventions is mostly likely due to: (1) the failure of the education and training to actually change the lifting behavior used by employees, and (2) the lack of an adequate system to reinforce the modified behavior. The purpose of this proposal is to demonstrate the effectiveness of an aggressive new intervention for training and maintaining lifting techniques. The proposed project will use a new tool, The LiftTrainerTM, developed by Innovative Sports Training. The tool, using a 3-dimensional motion tracking system, computes the instantaneous three-dimensional dynamic spine moments and provides an audible biofeedback signal proportional to the magnitude of the stress. The emphasis here is on combining biomechanical analysis and concepts from learning theory in a protocol focused on changing lifting behavior and quantifying the extent to which behavior is modified. Workers performing simulated job tasks are coached in one-on-one training sessions of 30 minute duration in how to minimize their spine moments while maintaining an acceptable task performance speed. Moment data gathered at the beginning and end of a session are used to quantify improvement within a session and retention between sessions. Behavior is maintained through the incorporation of reinforcement techniques borrowed from behavioral based safety programs and repeated training. The aims of this project are: (1) to validate that lifting behaviors and the resulting spine moments can be modified in workers who perform repetitive material handling jobs (warehousing and distribution) as suggested by our pilot study, and (2) to determine the extent to which injury rates can be controlled through an aggressive training approach. In this study over 2,400 employees from multiple facilities will be randomly assigned to receive with the LiftTrainer to view a back education video. The LiftTrainer protocol requires that each assigned employee participate in two sessions initially. Based on performance and retention levels after two sessions, employees needing additional training will be identified and retrained. All employees in the LiftTrainer group will receive an additional three training sessions scheduled on a quarterly basis. These employees will be assigned to self-reinforcing teams established within each facility. The primary dependent measures include: quarterly injury rates, turnover rates, absenteeism, and lost time rates for each study group. In addition, within and between session changes in spine moments obtained for the LiftTrainer group will be tracked to determine how much change can be anticipated in the spine moments through training and the degree to which the changes are retained over time.